01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-02-27 | 22 | 2026-02-27 | 13 |
| Cycle 2 | 2024-12-20 | 28 | 2024-12-20 | 10 |
| Cycle 3 | 2024-01-05 | 29 | 2024-01-05 | 1 |
CMS CCN 0563132026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Pacific Villa, Inc
3501 Cedar Avenue · Long Beach, CA 90807 · Los Angeles County
Certified beds95CMS provider file
Recent citation rows103current CMS citation release
Penalty rows3current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
103 rows in the current release
2 rows carry G–L scope/severity codes; 0 carry J–L. 23 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-02-27 · HEALTHF0605Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0607Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0610Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0676Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0679Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0685Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Assist a resident in gaining access to vision and hearing services.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0697Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe, appropriate pain management for a resident who requires such services.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0726Severity D · isolated; potential for more than minimal harm
Nursing and Physician Services Deficiencies
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0757Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0790Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide routine and 24-hour emergency dental care for each resident.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0812Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0842Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0880Severity F · widespread; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · HEALTHF0881Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Implement a program that monitors antibiotic use.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0321Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0325Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Have properly installed hallway dispensers for alcohol-based hand rub.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0346Severity C · widespread; potential for minimal harm
Smoke Deficiencies
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0351Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Install an approved automatic sprinkler system.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0353Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0354Severity C · widespread; potential for minimal harm
Smoke Deficiencies
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0521Severity F · widespread; potential for more than minimal harm
Services Deficiencies
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Correction field: Deficient, Provider has date of correction · 2026-03-252026-02-27 · FIREK0712Severity C · widespread; potential for minimal harm
Miscellaneous Deficiencies
Have simulated fire drills held at unexpected times.
Correction field: Deficient, Provider has date of correction · 2026-03-2503 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-04-28 | Fine | $23,473 | 0 |
| 2024-02-20 | Fine | $2,279 | 0 |
| 2024-01-22 | Fine | $3,418 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- PACIFIC VILLA INCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 12/08/2014
- THE PALMS REAL ESTATE, LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 12/08/2014
- NELSON, WILLIAMIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/08/2014
- ROLLINS, VICKIIndividual · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/08/2014
- NELSON, WILLIAMIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 12/08/2014
- ROLLINS, VICKIIndividual · INDIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 04/28/2026
- NELSON, WILLIAMIndividual · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 12/08/2014
- ROLLINS, VICKIIndividual · 5% OR GREATER MORTGAGE INTERESTNOT APPLICABLE · since 12/08/2014
- NELSON, WILLIAMIndividual · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 12/08/2014
- ROLLINS, VICKIIndividual · 5% OR GREATER SECURITY INTERESTNOT APPLICABLE · since 12/08/2014
- NELSON, WILLIAMIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/08/2014
- ROLLINS, VICKIIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 12/08/2014
- NELSON, WILLIAMIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/08/2014
- ROLLINS, VICKIIndividual · CORPORATE OFFICERNOT APPLICABLE · since 12/08/2014
- ANDERSON, TREVORIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2024
- BUTED, LINAIndividual · OPERATIONAL/MANAGERIAL CONTROLNOT APPLICABLE · since 04/01/2026
- ANDERSON, TREVORIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/01/2024
- BUTED, LINAIndividual · ADP OF THE SNFNOT APPLICABLE · since 04/01/2026
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours4.06per resident day
RN hours0.22per resident day
Weekend nurse hours3.73per resident day
Staff turnover36.7%CMS reported field
06 / LOCAL RECORDS
Open the Long Beach ledger →Other published facilities nearby
Alamitos Belmont Health And Rehabilitation94 beds · CMS overall 3/550 citation rowsAtlantic Memorial Healthcare Center104 beds · CMS overall 5/531 citation rowsBay Vista Healthcare & Wellness Centre, Lp70 beds · CMS overall 2/569 citation rowsBeachside Post Acute90 beds · CMS overall 4/542 citation rowsBel Vista Healthcare Center41 beds · CMS overall 4/586 citation rowsBixby Towers Post-Acute Rehab99 beds · CMS overall 2/596 citation rowsBroadway By The Sea98 beds · CMS overall 1/594 citation rowsCatered Manor Care Center83 beds · CMS overall 3/570 citation rows